Download PDF | Innovation In Byzantine Medicine The Writings Of John Zacharias Aktouarios (c. 1275 C. 1330) Oxford University Press ( 2020)
361 Pages
Preface
This volume grew out of a King's College London PhD thesis on the same subject. It does, however, have one more chapter than my doctoral dissertation: Chapter 6, on John Zacharias Aktouarios’ On Psychic Pneuma. There have also been several revisions of the text to make the book more concise and accessible. The research for this project started sometime in the summer of 2011. There are many people I wish to thank. I am most immensely grateful to my primary PhD supervisor, Dionysios Stathakopoulos, who first aroused my interest in Byzantine medicine in my undergraduate years.
He has been a true teacher to me, demonstrating infinite generosity and patience with my various concerns over the last twelve years. I also wish to acknowledge a sincere debt to my secondary supervisor, Ludmilla Jordanova, who first initiated me into critical theory and read several drafts of my thesis, always providing thoughtful comments, which stimulated many ideas and prevented many mistakes.
I would also like to express my special thanks to Georgi Parpulov, whose continuous encouragement and support of my study of and research into numerous Greek manuscripts have been decisive. I am most grateful for his rare and unselfish friendship, transcending the strict boundaries of scholarship. Additionally, many thanks must go to my two PhD examiners, Peregrine Horden and Manfred Horstmanshoff, for their insightful suggestions during and after my examination. In particular, Peregrine's advice has been significant in opening up my research to a wider Mediterranean conceptual approach. Since then he has also been a very generous and devoted mentor, tirelessly committed to both my work and my professional development.
Moreover, I have benefited significantly from the insightful comments of the anonymous reviewers at OUP, and from those scholars who have read sections of this book in various stages of its preparation: Sean Coughlin, Orly Lewis, Tassos Papacostas, Georgia Petridou, Alice Taylor, and Chiara Thumiger. I am grateful for bibliographical suggestions from their respective fields of expertise to Gerrit Bos, Fr Maximos Constas, Klaus-Dietrich Fischer, Erika Gielen, Florence Eliza Glaze, Monica Green, Fr Georgios Metallinos, Nikolai Serikoff, and Tess Tavormina. I am also indebted to all those Byzantinists and Historians of Medicine who encouraged me in crucial stages of my career to keep working on Byzantine medicine, and, in particular, Judith Herrin, the late Ruth Macrides, Maria Mavroudi, Julius Rocca, and Thomas Rütten.
I would also like to thank Vassilios Kokkalis, my school science teacher, as well as my supervisors from my undergraduate days in London, particularly Hugh Bowden and Dominic Rathbone, and Marc Lauxtermann, my supervisor for my Master's at the University of Oxford. Special thanks should also go to Elizabeth Jeffreys, who encouraged me to submit this monograph to the Oxford Studies in Byzantium series and Charlotte Loveridge and Georgina Leighton from OUP for their constant kindness and professionalism.
I most grateful to the Alexander S. Onassis Public Benefit Foundation for the generous award it granted me to bring my doctoral thesis to its completion. I would also like to thank the Arts and Humanities Research Council, the А. С. Leventis Foundation, and Schilizzi Foundation, which awarded me further scholarships in the course of my graduate research. And I would not have been able to visit several libraries and archives abroad without the invaluable support of the Wellcome Trust (099354/Z/12/Z) and the Faculty of Arts and Humanities, King's College London.
А considerable period of my research was spent in Paris during an Erasmus Research studentship in the Université Paris-Sorbonne (Paris IV) and I am grateful to Béatrice Caseau for hosting me. I further benefited from a Junior Research Fellowship at the John W. Kluge Center of the Library of Congress, Washington DC, funded by the Arts and Humanities Research Council. The library itself was an ideal place for research and I am indebted to Mary Lou Reker, Special Assistant to the Director. While in Washington, I had the pleasure of visiting Dumbarton Oaks Research Library and using its collections at the kind invitation of Margaret Mullet, Director of Byzantine Studies. I am also grateful to Alain Touwaide for allowing me to access his rich microfilm collection at the Department of Botany in the Smithsonian. I am most grateful to the following libraries and institutions for allowing in situ access to manuscripts and for providing me with images and permission to reproduce them: Library of the Hellenic Parliament, National Library of Greece (both Athens); Library of Iviron Monastery (Mount Athos); Staatsbibliothek (Berlin); Bibliotheca Universitaria (Bologna); Bibliothéque royale de Belgique (Brussels); Gonville and Caius College Library, St John's College Library, Wren Library Trinity College (all Cambridge); Real Biblioteca del Monasterio (San Lorenzo de El Escorial); Biblioteca Medicea Laurenziana, Biblioteca Riccardiana (both Florence); University Library (Glasgow); Universiteitsbibliotheek (Leiden); Universitatsbibliothek (Leipzig); British Library, Wellcome Library, Woolff Gallery (all London); Biblioteca Nacional de España (Madrid); Biblioteca Ambrosiana (Milan); Bayerische Staatsbibliothek (Munich); Biblioteca nazionale (Naples); Bodleian Library (Oxford); Biblioteca centrale della Regione Siciliana (Palermo); Bibliothéque nationale de France (Paris); Biblioteca Angelica (Rome); Patriarchal Institute for Patristic Studies (Thessaloniki); Biblioteca nazionale universitaria (Turin); Biblioteca Apostolica (Vatican City); Biblioteca nazionale Marciana (Venice); Biblioteca capitolare, Biblioteca civica (both Verona) and Osterreichische Nationalbibliothek (Vienna).
Finally, this thesis would not have been written without the love and support of my parents Αγγελική and Ἀριστοτέλης, my sisters Βασιλική and Δέσποινα, my brother Γεράσιμος, my aunt Ἀργυρώ, and my uncle Γέρων Γεράσιμος Ἁγιοπαυλίτης. The biggest thank you is reserved for my wife, Sophia Xenophontos, not only for helping unravel some of the abstruse language of John Zacharias Aktouarios in translation, but also for being the primary source of wise counsel and inspiration.
Petros Bouras-Vallianatos Edinburgh April 2019
Note to the Reader
АП quotations from Greek and Latin have been translated into English by me, unless otherwise stated. Passages from John's works have not always been rendered word for word, since sometimes a more flexible translation can better convey the main ideas, especially given his dense prose. Where an implied word (or words) needs to be made explicit for reasons of clarity, it is supplied within angle brackets, e.g. ‘The «patient» remained calm on the first day.’ The original Greek text of the passages provided in English translation is always cited in the corresponding footnote. Greek terms or brief phrases are usually given in transliteration throughout the main text to facilitate the consultation of the book by those with very little or no knowledge of Greek. Transliteration of Greek and Arabic terms follows in most cases the Library of Congress system.
Proper names of ancient authors follow LSJ. The spelling of Byzantine names generally follows The Oxford Dictionary of Byzantium (ODB), e.g. "Aetios of Amida’ rather than "Aetius of Amida’. The exact dates of ancient Greek, Latin, and Byzantine authors are rarely known and the dates given are only approximations following Antike Medizin: ein Lexikon (2005), The Oxford Classical Dictionary (OCD), and ODB. Primary sources are cited by the name of the author, followed by the title of the work, the numbering of the traditional division into books and/or sections where applicable, as well as a reference to the edition (volume in Roman numerals, page and line in Arabic numerals), e.g. Theophilos, On Urines, 7.1, ed. Ideler (1841) 1.268.7-8. By convention, texts in the Hippocratic Corpus are referred to as being by [Hippocrates]. My references to John's edited works follow the division by Ideler (1841-2). John's On the Activities and Affections of the Psychic Pneuma and the Corresponding Regimen is abbreviated to On Psychic Pneuma. I prefer to place John's office (aktouarios) after his surname and to give it a capital letter (John Zacharias Aktouarios=JZA) in line with its most common use in secondary sources. For the unedited parts of John's Medical Epitome I always provide the reference to the early Latin printed edition by Mathys (1556). For secondary sources, I follow the Harvard author-date system, e.g. Biran (2015: 550-3).
Transcriptions of John's Medical Epitome are based on Vindobonensis med. gr. 17 (V) and occasionally important variant readings from Scorialensis Φ.ΠΙ.12 (E) are also supplied (see also Appendix 5). Transcriptions from Greek retain the same spelling and punctuation as in the relevant codex, apart from the fact that I have supplied the iota subscript. Dates of manuscripts accurate dating is given in a recent study, which is cited accordingly.
Lastly, I use the term ‘clinical’ throughout this book to denote the direct observation of a certain patient by a physician without implying a particular ‘healing space’, such as a clinic or hospital.
Introduction
In this book I examine the works of the late Byzantine practising physician and medical author John Zacharias Aktouarios (c.1275—c.1330), who lived and worked in Constantinople. It represents a substantial part of a project I have had in mind since my postgraduate studies, which involves placing the Byzantine medical tradition on equal terms alongside the Latin and Islamic medical traditions in the study of the medieval Mediterranean world. In this respect, it seeks to get away from prejudices that regard Byzantine medical literature as stagnant and not having made any significant contribution to the history of medicine, apart from the preservation and transmission of ancient Greek medical knowledge." Furthermore, this book aims to motivate Byzantinists to make use of evidence from medical literature in the study and wider evaluation of Byzantine society and culture. I also hope this study inspires long overdue critical editions, commentaries, translations, and more comprehensive studies of Byzantine medical works.
John's works indisputably circulated in large numbers, which makes him a unique case, not only in Byzantine medical literature, but also in the entire literary production of the Byzantine world. Although his connections with other contemporary scholars and his basic biographical details have been delineated in the past, an evaluation of his medical corpus has not hitherto been attempted. Consequently, his reputation is based on the comments of earlier authorities, which have been being repeated uncritically since the nineteenth century. In this monograph, I would like to show that in John's writings it is clear that Byzantine medicine was remarkably open to foreign knowledge and had a significant degree of originality, in particular, in the fields of uroscopy, pharmacology, and human physiology.
My analysis of John's works is based on a close textual examination that aims to contextualize his contribution to the development of medical thought and practice in Byzantium. Furthermore, by comparing John's contributions with examples from the Islamic and medieval Latin world, I place John's world of thought in a wider Mediterranean milieu and highlight the cultural exchanges between Byzantium and its neighbours. In this endeavour, I have used evidence from a wide variety of medical sources, including previously unedited material, and texts from other genres, such as epistolography and merchants' accounts, in order to see John's writings in the light of the contemporary social and cultural environment. In assessing John's corpus, I deal with each of his works in individual chapters. Each chapter and subsection follows a general-to-specific approach, providing background details to help the reader better understand the more specialized discussions on various sections of John's works.
This introduction (Chapter 1) aims to serve a dual role. Before embarking on the close examination of John's works, I wish first to situate John within his medical and social context. Secondly, this chapter gives an introductory account of John's biography and corpus. After Chapter 1, I examine John's original approach in On Urines, paying particular attention to his discussion of various urinary features and his introduction of a detailed graduated urine vial (Chapter 2). John's case histories discussing his interaction with patients, which are unique in Byzantine medical literature, are examined separately (Chapter 3). In contrast to On Urines, the Medical Epitome is mainly a compilation of earlier material and belongs to the genre of Byzantine 'encyclopedic' medical handbooks. Thus, the focus here is on John's sources, analysed through selected case studies. Ultimately, I argue that the work was primarily written for philiatroi, ‘friends of medicine’ or ‘amateur physicians’ (Chapter 4). John’s pharmacology, which, as I shall show, attests a significant influence from Arabic pharmacological lore, is examined in Chapter 5. Since John’s Medical Epitome is partly unedited, a study of all surviving manuscripts helps to reconstruct textual inconsistencies and make otherwise unedited material available to the reader (Appendix 5). Chapter 6 concentrates on John's original contributions to pneumatic physiology as presented in his On Psychic Pneuma. Lastly, Chapter 7 sums up John's achievements and outlines important aspects of the noteworthy reception of his works during the centuries following his death.
1. BYZANTINE MEDICAL LITERATURE 1.1 The ancient background
The single most influential premodern medical method for diagnosing and treating illness in the human body was the Hippocratic theory of the four humours, first outlined in the Hippocratic text On the Nature of Man composed in the late fifth century sc.” According to this theory, the body was made up of blood (haima), phlegm (phlegma), yellow bile (chole), and black bile (melaina chole). Later on, Galen (ΑΡ 129-216/17) aligned the four humours with the four elements? Each humour was connected with a particular season and two of the four elementary qualities (hot or cold, and dry or moist). Blood was the dominant humour in spring and was marked by the hot and moist quality. Similarly, yellow bile was the main humour in summer and was hot and dry. Phlegm was cold and moist and associated with winter; finally, black bile, like autumn, was cold and dry. Galen refers to nine kinds of bodily mixtures, one ‘good mixture’ (eukrasia), in which all elementary qualities are in the same proportion and eight ‘bad mixtures’ (dyskrasiai), which were considered to be the result of an excess of one or two qualities and denoted a predisposition to certain kinds of disease.* Each human being had his or her own natural mixture (krasis). A physician was supposed to be able to counterbalance the qualities by prescribing a suitable diet or the administration of the appropriate drugs, to which particular qualities were assigned, or to remove the noxious humour using various techniques of bloodletting, thus restoring the patient's natural mixture.
By Galen's time there were three main ‘schools’ of medical thought and practice, i.e. the Dogmatists or Rationalists, who considered the search for the cause of disease an important part of their attempts to cure; the Empiricists, who gave a central role to the physician's past experience; and the Methodists, who applied a specific method or path in the process of healing.’ Galen gave particular prominence to the Hippocratic concepts of health and disease, although his theories were often characterized by a considerable degree of eclecticism. He produced more works than any other author in antiquity, making a significant contribution to the understanding and establishing of numerous medical disciplines.? His medical ideas shaped ancient medicine and for well over a millennium Galenism, i.e. the medical system based on Galen's theories, would constitute the main dogma in rational medical approaches. Hippocratic and Galenic works were extensively copied and greatly influenced Byzantine authors and practitioners.
1.2 The early Byzantine period (fourth-seventh centuries)
The medical literature of the early Byzantine period can be divided into two main categories, each corresponding to the basic purpose the texts were intended to serve.’ First, this period saw the production of ‘encyclopedic’ medical handbooks intended to help their readers consult practical recommendations, mainly diagnostic and therapeutic, in the accessible format of a single volume. Although these works consisted of quotations from earlier authors, recent studies have emphasized the important role of early Byzantine authors in the shaping of a medical tradition and rearranging otherwise chaotic material into a systematic and user-friendly form."
Oribasios (Ар c.325-after 395/6), friend and personal physician of the wellknown pagan Emperor Julian (Ap 361-3), was the first to produce a large-scale summary of primarily Galenic medical knowledge. His Medical Collections is a work originally consisting of seventy books, of which almost one third have survived. Alongside Galen, Oribasios also cites the Hippocratic corpus and Dioscorides (first century Ap), as well as Antyllus (c. first half of the second century AD), Rufus of Ephesos (fl. Ap 100), Soranus (second half of the first century/early second century Ap), and Archigenes (second half of the first century-first half of the second century Ар). An abridged version of the Medical Collections is the Synopsis for Eustathios, in nine books, composed for Oribasios’ son; this is meant as a vade mecum used by travellers or for medical emergencies.^ In another work, the For Eunapios, Oribasios was again heavily influenced by the Medical Collections, although in this case providing succinct medical advice to his friend Eunapios, a philiatros, is a central part of his agenda.
Oribasios technique of using quotations from earlier authors was later followed by Aetios of Amida (fl. first half of the sixth century ap) in his vast work the Tetrabiblos, and Paul of Aegina (late sixth century-d. after Ap 642) in his Epitome. Aetios seems to have been significantly less dependent on Galen than Oribasios was. Interestingly, Oribasios is often mentioned among Aetios' sources, alongside frequent references to Dioscorides, Hippocrates, Antyllus, Rufus, Soranus, Archigenes, Herodotus, Philumenus (second/third century Ар), and many other minor authors, including a certain Andrew the Count
(komés) and a woman author called Aspasia.'^ In the Tetrabiblos, there are also recipes attributed to Jewish prophets, Egyptian kings, and Christian apostles and bishops. Unlike Oribasios and Aetios, Paul aimed to offer a condensed version of the most up-to-date medical knowledge for immediate consultation, which could be carried everywhere by physicians in the way lawyers carried legal synopses.'? Perhaps book six, on surgery, was the single most influential part of Paul's work." In it, Paul often quotes from various now-lost accounts on the subject by authors such as Antyllus and Leonides (c. first century AD).
Alexander of Tralles (Ap c.525-c.605), on the other hand, as a result of his own extensive clinical experience, produced a medical handbook marked by his strong authorial presence and his persistent attempts to supplement preexisting material with new elements.'? His main work, the Therapeutics, is not a medical handbook sensu stricto; for example, Alexander excluded invasive surgery when used as a method of punishment rather than cure. Moreover, his independent attitude should be emphasized; he does not hesitate even to disagree with the ‘most divine’ (theiotatos) Galen.? His monographs On Fevers and On Intestinal Worms show his concern to provide up-to-date material on a variety of medical subjects. In close connection with these early Byzantine medical handbooks, we can also cite the Hippiatrica, a compilation of excerpts on horse medicine, which most probably dates to the fifth/ sixth century Αρ.
The fifth to the seventh centuries, in particular, was a period that was also marked by the production of texts of a clearly didactic nature, such as commentaries and summaries, which were connected with the teaching of medicine in the scholastic environment of Alexandria.”’ These texts were aimed at complementing the study of the Hippocratic and Galenic works that formed the Alexandrian curriculum.” Although only a small proportion of these texts, by authors such as Stephen and John of Alexandria, survives nowadays in the original Greek, others are accessible through Arabic translations.?
1.3 The middle and late Byzantine period (eighth-fifteenth centuries)
Similar medical handbooks were written over the next few centuries. Paul of Nicaea (before ninth/tenth century) composed his work in the form of an erotapokrisis (questions and answers) in 137 short chapters.** Theophanes Chrysobalantes (c. tenth century), writing most probably for Constantine VII Porphyrogennetos (sole r. 945-59), penned his Synopsis summing up the findings of Greek and early Byzantine medical authors. Leo the Physician (ninth[?] century), presumably writing for his pupil George"? produced the so-called Synopsis of Medicine, an epitome in often aphoristic form in seven books." We can also place John Zacharias Aktouarios’ Medical Epitome, which combines earlier Greek and Byzantine sources with recently introduced Arabic medical knowledge, in the same tradition.
The period was also marked by the writing of monographs on a variety of medical disciplines, based on the reworking of earlier material and supplemented according to the various authors' expertise. For example, in the field of diagnostics, Theophilos (seventh or ninth century) composed influential works on pulse, urine, and excrement.’ Theophilos also composed the On the Constitution of Man, which takes its starting point from the teleological explanations of the human body as expounded by Galen in his On the Function of the Parts of the Body, and is supplemented with references to the Christian God, who created the human body with wisdom (sophia) and providence (pronoia).? More interesting in terms of the assembled material is the work on Christian anthropology, On the Constitution of Man, by Meletios (ninth[?] century)? Symeon Seth (fl. second half of the eleventh century) wrote his Treatise on the Capacities of Foodstuffs marking the introduction of Arabic medical knowledge to Byzantium?! Furthermore, he was the author of Refutation of Galen, a brief work, belonging to the genre of antirrhesis (refutation), in which Symeon criticized a number of Galenic views on human physiology, which—given Galen's deified status in Byzantium— makes it unique in the entire Byzantine period.?? The most extensive Byzantine work on pharmacology, the Dynameron by the so-called Nicholas Myrepsos was most probably compiled by the late thirteenth century.? The author under examination in this book, John Zacharias Aktouarios, composed long specialized works on uroscopy and human physiology in the early fourteenth century.
In addition to the aforementioned medical works, from at least the twelfth century onwards, a substantial number of collections of recipes, the so-called iatrosophia, were produced, often in the vernacular.** This is a somewhat neglected category of medical texts in which the main focus is on diagnosis and therapy. They are written in a simple way, so that they can be used in daily practice, and can fill an entire volume or just a couple of folia. As for their therapeutic recommendations, there is a strong emphasis on pharmacology, although they may include instructions on non-invasive surgical procedures, e.g. phlebotomy, and also popular elements, such as magic spells and biblical lore.
Lastly, from the eleventh/twelfth century onwards, there is also growing circulation of Arabic and Persian works in Greek translation? The most notable examples are the Ephodia tou Apodemountos (Ат. Zad al-Musafir wa-Qut al-HadirlProvisions for the Traveller and Nourishment for the Sedentary/ Lat. Viaticum) of Ibn al-Jazzar (fl. tenth century),* a short text on smallpox and measles, Peri Loimikes (Ar. Kitab fi al-Judari wa-al-Hasbah/Treatise on Smallpox and Measles), by Muhammad ibn Zakariya’ al-Ràzi (d. c.925),7 and some antidotaries in Greek translation by George-Gregory Chioniades (c.1240/50-c.1320) and Constantine Melitiniotes (fourteenth century [?]).%
2. THE SETTING 2.1 Byzantium in the time of John
In April 1204 the armies of the Fourth Crusade conquered Constantinople and founded the short-lived Latin Empire of Constantinople (1204-61). The Byzantines managed to keep under their control some smaller regions, following the creation of the successor states of Epiros (mainly western Greece), Trebizond (the eponymous city on the south-eastern shore of the Black Sea and its hinterland), and Nicaea (chiefly western Asia Minor, including areas of Macedonia and Thrace from the late 1240s). At the same time, a number of Latin states emerged on the Greek mainland and in the Aegean islands, varying in extent and authority. The most notable and long-lasting example is certainly that of Venice, which managed to maintain its outposts until 1669 and 1797 in the case of Crete and the Ionian Islands respectively. The presence of Latins in the former territory of the Byzantine Empire gradually led to contact between East and West, which developed the exchange of ideas.
Michael VIII Palaiologos, having meanwhile been proclaimed co-emperor of the Empire of Nicaea in 1259, managed to recapture Constantinople in 1261 without meeting any significant resistance and restored the Byzantine Empire.*° The official ascent of the Palaiologan dynasty to the imperial throne of Byzantium, where it would remain until the Fall of Constantinople in 1453, went hand in hand with a steady decline in the Empire's territory. Asia Minor was gradually overrun by a number of post-Seljuk beyliks, in which the Ottoman Turks became the most powerful presence, ultimately conquering Byzantium itself. In addition to the Turks, Michael VIII was facing the danger of a new crusade, organized by Charles of Anjou (r. 1266-85) in order to recapture Constantinople. Among the measures immediately taken by Michael was accepting the Union of the Churches after sending his delegates to the Second Council of Lyons in 1274." This caused a long internal ecclesiastical schism in Byzantium between Unionists and anti-Unionists.
Immediately after Michael VIIT's death, his son and successor to the throne Andronikos II repudiated the Union and recalled from exile numerous antiUnionists.“ Meanwhile, bands of Turks had managed to reach Thrace, while Serbs and Bulgarians from the north were becoming an increasing threat. Andronikos' response was to increase the number of mercenaries, who—as in the case of the Catalan Company—sometimes proved extremely treacherous, and even subsequently established themselves in the territory of the Empire. Andronikos' last years were marked by internal and external instability. The problematic conditions on the frontiers were intensified by conflict between Andronikos II and his grandson Andronikos III (r. 1328-41), while the Hesychast religious controversy—an intense theological dispute starting in about 1337 between supporters and opponents of Gregory Palamas (c.1296-1359)—caused more troubles in an already turbulent environment.” In contrast to the territorial decline and political corruption of high imperial administrators, literary and artistic production flourished in this period.
2.2 Early Palaiologan cultural revival (1261-1341)
The early Palaiologan period is marked by the prolific intellectual activity of an extremely large number of individuals and the wide variety of fields of expertise to which they often made original contributions.“* Ihor Ševčenko has enumerated ninety-one Byzantine scholars who were active in the fourteenth century alone.? These intellectuals sometimes served in high imperial offices (e.g. Nikephoros Choumnos, Theodore Metochites).*^ Other scholars spent their lives as members of the clergy (e.g. George Pachymeres, Joseph Rhakendytes), or served in high ecclesiastical offices (e.g. George of Cyprus, who was Ecumenical Patriarch under the name of Gregory II between 1283 and 1289). Many of them have left surviving works—although they are usually only available in poor editions or are as yet unpublished— pointing to an active intellectual engagement with various subject areas, such as philosophy, rhetoric, and astronomy. I shall give a few representative examples of these literati which will offer interesting comparisons with John's career and writing activity, focusing on the early Palaiologan period, i.e. mainly from 1261 to 1341.
Already in the Empire of Nicaea (1204-61) we can see the first signs of this cultural movement. The temporary exile, combined with the strong anti-Latin sentiments of the period, created the need for an identity. Respect for the Greek past, including ancient Greek literature and the remains of Greek cities in Asia Minor, noticeably revived.“ Emperor John III Vatatzes (r. 1222-54) proved a keen sponsor of education, founding libraries and supporting scholars such as Nikephoros Blemmydes (1197/8-c.1269), who wrote on a variety of subjects from theology to philosophy. Blemmydes is also well known as a teacher; among his students was the emperor and scholar Theodore II Laskaris (1254-8). Later on, in Constantinople, both Michael УШ and Andronikos IL as well as various patriarchs, were significant patrons of education and learning, restoring schools and funding teachers.??
Elementary education, the enkyklios paideia, consisted of the study of grammar, the Iliad and other poetry, logic, and rhetoric. Higher education involved the study of the so-called quadrivium, comprising arithmetic, music, geometry, and astronomy. The most notable schoolmasters and scholars of the late thirteenth century in Constantinople, such as George of Cyprus (c.1241-90), George Pachymeres (1242-c.1310), Maximos Planoudes (с.1255-с.1305), and Manuel Bryennios (fl. c.1300), composed their own quadrivia or commented on earlier versions thereof.” Scholars also had an active cultural life, connected to each other through exchanges of letters and also through gatherings, theatra, in which they could, for example, perform rhetorical set pieces or debate philosophy.**
Maximos Planoudes was certainly the leading figure in the early period, not only in the area of education, running his own school probably at the monastery of Chora before moving to the monastery of Akataleptos around 1300, but also in Palaiologan scholarship. He edited a large number of ancient works of various genres, including historiography and mathematics, usually providing his own scholia.? Furthermore, he composed several orations and wrote grammars, paraphrases, and commentaries on the works of the poet Theocritus (fl. third century вс) and the rhetorician Hermogenes (fl. late second century AD) to facilitate the study of ancient Greek literature. He is also the author of a special treatise on Indian numbers,” which had been introduced to Byzantium some years earlier, and is credited with the revival of the study of geography by undertaking the enormous project of editing Ptolemy's Geography, including the creation of twenty-six revised regional maps.”
Among Planoudes' most remarkable achievements are undoubtedly his Greek translations of Latin texts on grammar, theology, and philosophy.?? Other examples of translations from Latin into Greek include the work of Demetrios Kydones (c.1324-c.1398), who translated many theological works, such as Thomas Aquinas’ Summa Theologica.” We can also attest the introduction of a significant amount of scientific knowledge from the East in this period, manifested in the production of Greek translations of Arabic and Persian treatises in the fields of astronomy and medicine? There was also considerable influence from this cultural milieu on the astronomical works of George-Gregory Chioniades and George Chrysokokkes (fl. 1335-50), a scholar from Trebizond.” Interestingly, Chioniades died in Trebizond, having first been appointed as a Christian bishop at the IIkhanid capital Tabriz.°°
Another notable scholar of the period is Theodore Metochites (1270-1332), who was also an active and influential statesman serving at the highest levels as mesazon (personal adviser) and megas logothetés (prime minister) in Andronikos 175 reign.?' Metochites wrote on a variety of subjects. His Introduction to Astronomy (Stoicheiosis Astronomike) consists of a three-part introduction to Ptolemaic astronomy, including an early proposal for the revision of the Julian calendar.?^ His other works include commentaries on Aristotle's works, contributing—together with the numerous paraphrases and commentaries by his contemporary George Pachymeres?—to a significant resurgence of Aristotelian philosophy; twenty long poems; the Sententious Remarks (Semeioseis Gnomikai), a collection of 120 essays, often reflecting Metochites’ personal experiences; and eighteen orations, including his exhortation (logos protreptikos) on education, Ethikos, and the Presbeutikos, which deals with an embassy to a foreign court.5?
Metochites' influential role in the imperial administration allowed him to amass great wealth, which he then partly used to fund the renovation of the Chora monastery between 1316-21, including the production of monumental mosaics and frescoes with sophisticated iconography and style, ^? and to acquire a large collection of manuscripts. This subsequently passed to his favourite student, the polymath Nikephoros Gregoras. In addition to his monumental Roman History, Gregoras (с.1293/4-с.1359/1360) wrote on grammar, theology, philosophy, mathematics, and astronomy.” He proposed a calendar reform for calculating the date of Easter to Andronikos II (almost two centuries before the Western calendar reform introduced by Pope Gregory XIII in 1582), although it was not ultimately adopted. In his works Gregoras also demonstrates the appropriation of classical genres, as in his Phlorentios, or On Wisdom, a contemporary dialogue in Platonic guise focusing on the theological controversy with Barlaam of Calabria.?
In addition to Constantinople, there were also notable scholars based in Thessaloniki, the second most important intellectual centre of the period."? Thomas Magistros (c.1280-after 1347/8) compiled a dictionary of Attic terms to help contemporary scholars make proper use of pure Attic Greek.” His scholia on Aeschylus' Persians provide links with the contemporary siege of the city by the Turks, thus showing his engagement with current politics. Another important intellectual active in the city is Demetrios Triklinios (fl. c.1300—25), scholiast and editor of Greek tragedies and comedies, including previously neglected ones such as Aeschylus’ Agamemnon and Eumenides.?
3. STUDIES OF JOHN ZACHARIAS AKTOUARIOS AND HIS CORPUS
Charles du Cange, in his massive glossary of medieval Greek published in 1688, was the first to note John's dedications of his works to Joseph Rhakendytes (c.1260-c.1330) and Alexios Apokaukos (clate 1280s-d. 1345). Almost a century later, the English physician John Freind, in his The History of Physick published in 1724, made the first notable assessment of John's medical works."* Freind showed a particular interest in diagnosis and pharmacology. He concentrated on John's Medical Epitome, rightly pointing to Galen, Aetios of Amida, and Paul of Aegina as John's main sources.? Freind also emphasized John's numerous references to oriental materia medica, such as the various kinds of myrobalan.”° It was not until the early nineteenth century that John’s corpus attracted more interest from historians of medicine. In particular, the German physician and medical historian Justus Friedrich Karl Hecker made the first comprehensive study of John's works in his monumental Geschichte der Heilkunde published in 1829." Hecker highlighted John's independent attitude in his On Urines, referring to various urinary characteristics treated by John in detail, such as his mention of the urine crown (stephané).’”* On the other hand, he arbitrarily attributed the earliest mention of whipworm (Trichocephalus dispar) to John, although there is no explicit mention of it in John's Medical Epitome.” Overall, Hecker's analysis suffered from the fact that he based himself on the Latin editions of the works and from the trend among medical historians of his day for examining ancient and medieval medical works from a retrospective point of view, i.e. using modern terminology to refer to diseases and symptoms mentioned in ancient and medieval texts.*° In 1887, the German ophthalmologist and historian Julius Hirschberg provided a German translation of John's section on ophthalmology, pointing out John's detailed description of various ophthalmic conditions."
Although an edition of a large part of John's works in Greek was published in 1841-2 by the German philologist and naturalist Julius Ludwig Ideler,?? all subsequent historians of medicine relied on Hecker's comments, making only general reference to the exceptional nature of John's contribution.?? Their views were aptly illustrated by the Belgian-born American chemist and historian George Sarton who, in the first part of the third volume of his vast Introduction to the History of Science published in 1947, stated: "The outstanding doctor of the age of the Palaiologoi was the court physician Joannes Actuarios. He closes the series of the great Byzantine physicians. His works were used considerably not only in the Christian East but also in the West, being read in Latin translation until the middle of the sixteenth century and even later.’**
Later on in the mid twentieth century, the great medical historian Oswei Temkin—attempting to revise our understanding of Byzantine medicine— underlined the lack of any serious study on John’s work, stating bluntly: “Yet I hesitate to include him in my discussion. ^? The next noteworthy mention of John's works is found in Herbert Hunger's monumental history of Byzantine literature.*^ In his otherwise reliable handbook, Hunger misattributed John's active career to Andronikos ПГѕ reign. He expressed admiration for John's literary output and presented his Medical Epitome as his magnum opus—a view which continues to be held to this day. However, as will be shown in this book, if such a title must be awarded, it should go to On Urines. Hunger marginalized John's original contributions on uroscopy and made no reference to John's encounters with patients. It was not until the 1970s that particular attention was paid to On Urines. For example, Konstantin Dimitriadis offered the first brief critical overview of John's uroscopic theories." Later on, Fridolf Kudlien argued that in his On Urines John attacked those doctors who relied solely on clinical experience (peira).?? Nevertheless, John shows that both theoretical knowledge (logos) and the knowledge gained from peira are essential elements for a practising physician, and he does not consider one attribute more important than the other.”
In subsequent years, Stavros Kourousis’ meticulous study of the collected letters of George Lakapenos—John’s good friend and fellow scholar— provided important information about John's life and 'scholarly' networking in Constantinople.” He revealed details about John’s studies in medicine and showed his clear connection with the circle of Maximos Planoudes' (с.1255-с.1305) students. In another study of letters relating to John’s activity, he established John's approximate date of birth (1275) and confirmed the absence of any evidence about his life after 1328, thus connecting his floruit with the second half of the reign of Andronikos II (1282-1328).?' Moreover, in the same study, Kourousis was the first to present brief summaries of John's case histories. A few years later, he wrote a long monograph,” of which the greater part deals with his unconvincing argumentation, seeking to assign the authorship of three early Palaiologan texts in dialogic form (Hermodotos, Mousoklés, and Hermippos) on philosophy and astronomy to John.?? In his attempt to present the author of the anonymous texts as medically aware, Kourousis exaggerated the use of references with medical connotations in these dialogues and did not provide a critical assessment of his selection of supposed cross-referenced passages between these dialogues and John's medical corpus.”* In his long study on the three dialogues, Armin Hohlweg advanced several counterproposals to Kourousis' argumentation, demonstrating that it was impossible to identify John as the author of the three dialogues. He argued instead in favour of the authorship by Nikephoros Gregoras.” Hohlweg's study was rejected by Kourousis, who reaffirmed his attribution of the dialogues to John in a new study some years later.?^? The evidence given by both scholars is inconclusive and I prefer to treat those three works as unattributed.
In Kourousis’ monograph significant attention is given to John's work On Psychic Pneuma, which is also discussed by Hohlweg in a brief study.” Both Byzantine philologists presented John's work from a philosophical point of view, attempting to relate his theories to the writings of Neoplatonic philosophers and the Church Fathers, and thereby omitting John's medical contributions to human physiology. John and his corpus were the subject of an article written by Hohlweg in 1983, in which he announced his critical edition of the Medical Epitome, which was unfortunately never published.?* Hohlweg rightly pointed out the innovative character of John's On Urines and provided a short description of its contents. He also gave a useful overview of the unedited part of the Medical Epitome. However, he made no particular attempt to investigate further and restricted himself to mentioning Hecker's comments uncritically. In conclusion, he considered John's Medical Epitome a specialized work written for contemporary physicians, contradicting the conclusion of the present volume, which shows that the work is primarily written for the non-expert.
Timothy Miller's conclusions on John's activity in his monograph on Byzantine hospitals are often not substantiated by the available evidence in primary sources.” Although earlier studies by Kourousis and Hohlweg on John's basic biographical details had been available for at least a decade before the second revised edition of this work, Miller presented John as court physician in Andronikos П reign. The erratic nature of Miller's statements is further illustrated in his description of the Mangana xenon as a fullyfunctioning medicalized hospital and his identification of John as one of its physicians, without presenting any evidence for the restoration of this particular xenón after 1261 or to support John's affiliation with it;'^? he consequently considered John's case histories an outcome of his xenon experience.”
Scholars have generally given little attention to John's diagnostic methods. The only notable exception is Emilie Savage-Smith who, in her article on Byzantine ophthalmology, highlighted John's awareness of the differential diagnosis of eye affections.'^? Aristotelis Eftychiadis referred to some isolated examples of John's pharmacology in his book on Byzantine therapeutics, although his non-comparative approach limits the interpretive value of the study.'^? John’s vast work on uroscopy was discussed from various perspectives in the collection of essays on the history of nephrology edited by the nephrologist Thanasis Diamandopoulos. This study often takes a retrospective analysis approach.'^* In Diamandopoulos' later study, co-written with Pavlos Goudas, the authors outlined for the first time some interesting data from John’s work, including some inconclusive details on John’s theory of the four digestions.'?? Moreover, in the doctoral thesis of Antonia Kakavelaki on the role of pneuma in the works of Greek and Byzantine authors from a philosophical point of view, there is a special section on John's On Psychic Pneuma, in which the author points to some additional philosophical sources not previously mentioned, such as John Philoponos' commentary On Aristotle's on the Soul.'°° Finally, mention must be made of a long doctoral thesis by Stavroula Georgiou, which provides the first-ever critical edition of the first book of On Urines accompanied by a French translation and commentary.
4. THE MAN
4.1 John's connections with contemporary intellectuals: evidence from Palaiologan epistolography
We can deduce various details of John’s life and relationships with contemporary individuals from surviving letters addressed to him and one extant letter written by John.'?? The following letters (the particular letter(s) addressed to or concerning John is/are given in parenthesis) are of interest:'?? a) collection of letters by George Lakapenos and Andronikos Zarides (nos. 10, 18, and 20):115 b) John’s letter to Theodore Modenos;''! c) a collection of letters by Michael Gabras (nos. 22, 52, 310, and 439);''? d) a collection of letters by George Oinaiotes (nos. 43, 168, 171, and 174).77
The first collection consists of thirty-two letters and includes the correspondence of the Palaiologan intellectuals George Lakapenos (fl. c.1297-1310/11, d. before 1315) and Andronikos Zarides (fl. c.1300-15), both ex-students of Maximos Planoudes.'"* George Lakapenos is known as the author of educational textbooks, including his epistles and associated epimerismoi (elementary word-by-word comments, grammar, syntax, and vocabulary, on texts intended for school use), works on grammar and syntax and an edition ofa collection of Libanios' (fourth century ap) letters and scholia, thus suggesting his activity as a teacher in Constantinople"? Andronikos Zarides, the author of some surviving letters, was a low-level imperial administrator. τό
Lakapenos sent Epistle 10 to John from Thessaloniki around autumn 1299.117 He addresses him as ‘Zacharias’ (to Zacharia), which is John's surname.!? John wants to travel to Thessaloniki from Constantinople to meet his friend. Lakapenos urges his friend to stay in Constantinople and complete his studies in medicine. According to the letter, John was currently attending a daily phrontistérion but, since he had not finished his education, he would not be able to reach the appropriate level of knowledge on the 'secrets' of medicine (orgion Hippokratous) to acquire the kerygmata.''? The word phrontisterion is associated with a place of education in Palaiologan sources,"? and Lakapenos’ reference to the term might be associated with some advanced tutorials on medicine by a contemporary schoolmaster, such as Planoudes. A later scholion in this letter provides another possibility associating the term with a xenón,"" a term which could denote one of Constantinople's hospitals.
In fact, the foundation charter (Typikon) of the Pantokrator xenon in Constantinople, which was established by John II Komnenos (r. 1118-43) in 1136, refers to the teaching of medicine in the framework of a medicalized hospital.” However, there are no other contemporary sources to confirm that such a school was actually functioning in the Pantokrator xenon, which was in any case a short-lived institution.'^* Furthermore, there is no further evidence to support the idea that there was consistent provision of medical education in хепдпеѕ.'?° The only exception is the case of John Argyropoulos (с.1393/4 or c.1415-87), who was giving lectures in medicine at the Katholikon Mouseion of the Kral xenon, annexed to the monastery of St John the Baptist in Constantinople.’*° But there is а gap of almost three centuries between this and the descriptions of the Pantokrator xenon in the Typikon. Consequently, it is not clear from Lakapenos' letter what kind of medical teaching John received and in what context, but it confirms some sort of medical teaching activity in Constantinople.
As for the word kerygmata, it suggests a kind of medical licensing system, perhaps something similar to the symbolon mentioned by Patriarch Leo Stypes (1134-43) in the twelfth century." In that case, the text states that those having received medical education and with long practical experience should be tested (proexetasas) before the supreme master of medical science (iatrikes proexarchén) like a ‘Lydian rock’ (Lydia lithos). If the master found them not unsatisfactory (оиК adokimon), he endowed them with the symbols of approbation (symbolon). This could refer either to a licence or a specific object that could attest their medical proficiency. It is clear that both texts confirm the existence of a process for granting an educated physician the right to practise, but it is unclear whether it is regulated by the state or by a guild of physicians. +?
To return to Lakapenos' Epistle 10, John had reported to Lakapenos in an earlier, no longer extant, letter that he lived in Constantinople with his mother, without referring to his father or a wife, but mentioning the financial difficulties he was currently facing.'?? More details about John's family are found in his sole surviving letter, addressed to a friend from Serres, Theodore Modenos. John wanted to visit his friend, who was ill,?' but his father’s lingering illness did not permit this.'?? Taking into consideration the absence of any reference to John's father in Lakapenos' letter, it would seem that John's letter to Theodore is likely to have preceded it and probably John's father had died at some point before 1299.'°° It is worth noting that John seems to have had friends in Serres, which—combined with the attestation of three, almost contemporary, people with the same surname as John in that city—could suggest it might have been John's place of origin.?*
There are two more letters in Lakapenos' collection, which, although not addressed to John, refer to him indirectly. Epistle 18 was sent by Lakapenos to Andronikos Zarides. Lakapenos is writing in connection with two books in which Zarides had shown an interest, one of which contains the Hippocratic Aphorisms. Zarides wanted to order a copy of it." However, before giving various details about the delay in the preparation of the copy, Lakapenos passes on John's greetings to Zarides, calling John the chief (koryphaion) of their friends. Thus, we can see that there is a friendly connection between John and Zarides, and also that Zarides had an interest in medical texts. In Epistle 20, sent by Lakapenos to Zarides between 1307 and 1309, John appears as the practising physician who had taken care of Lakapenos when he was ill.?" Here Lakapenos calls John an ‘able and mighty physician and philosopher’ (iatros tagathos krateros te philosophos), stressing his all-round medical education and expertise, and presenting him in the Galenic fashion as ‘physician cum philosopher’.’** Kourousis proposes that John’s friendship with Lakapenos and Zarides might suggest that John had also been a pupil of Planoudes,"?? but there is no conclusive evidence for this. Overall, we can deduce that John would probably have finished his studies and started practising medicine by around 1300 or shortly thereafter, and certainly before 1309. If John completed his advanced studies in medicine c.1300, he must have been born around 1275."*°
The next groups of letters, which offers important details regarding John's connection with the imperial court, is that of the writer and official of the imperial chancery, Michael Gabras (c.1290-d. after 1350). The collection includes 462 letters in chronological order dating to between 1308 and 1327. In Epistle 22, which is addressed to both George Lakapenos and John, Michael pleads with them to intervene on his behalf and introduce him to the circle of intellectuals associated with Andronikos IL'*"' He refers to some kind of meetings taking place in the evenings under the aegis of the emperor, probably alluding to a gathering of intellectuals. What Gabras says implies that both Lakapenos and John had good relations with the emperor.'^ Later on, Gabras sends John a letter (no. 52), including an oration, which he intends to perform in front of the emperor.'? Gabras asks John to provide him with his comments, thus confirming their close acquaintance and John's contacts with the imperial court. In the next two letters (nos. 310 and 439), Gabras supplements John's title with the term aktouarios,'** implying that John had at that point been appointed to this particular imperial office. In the second of these two letters, Gabras sends John a prayer, commenting on his admirable faith.'^? Given the chronological sequence of Gabras' letters, John must have been appointed aktouarios sometime between 1310 (Epistle 52) and 1323 (Epistle 310).'*° Lastly, it is notable that Gabras was once treated by a physician called Andronikos Zacharias." Although the synonymy and the profession might suggest a relation of John's, we have no other information about Andronikos Zacharias from contemporary sources.
The last collection of letters is that of George Oinaiotes. Some of his unedited Epistles (nos. 43, 168, 171, and 174) are addressed to a certain aktouarios (tō aktouario). Kourousis has convincingly shown that all four letters were addressed to the same person, who could not have been other than John, since the letters were sent between 1321 and 1327, a period when the office was held by him.'^ The letters contain details, which show that Oinaiotes was interested in the study of astronomy. According to Epistle 174, Oinaiotes received some sort of supervision from John in reading astronomical treatises.'^ Finally, in Epistle 43, Oinaiotes, having managed to attain aconsiderable level of knowledge in astronomy, asks John to intercede on his behalf and introduce him to the circle of astronomers under Theodore Metochites, who at that point held the office of the megas logothetés,’*° thus confirming John's eminent status among Palaiologan intellectuals.
4.1.1 The office of aktouarios
The office of aktouarios existed in early Byzantium, when it was related to the finances of the Empire.'?' From the twelfth century onwards there is consistent evidence of the association of this office with physicians. We first learn of an aktouarios who happened to be a physician in the Komnenian period, to be specific, in the monody of Michael Italikos on the physician and aktouarios Michael Pantechnes (d. ς.1130).7 Another notable physician and poet of the early twelfth century, ^? Nicholas Kallikles, had also been an aktouarios at some point, as is confirmed by a reference in the Ptochoprodromika.'^* Interestingly, Michael Pantechnes and Nicholas Kallikles were two of the three physicians attending the Emperor Alexios I Komnenos (r. 1081-1118) during his final illness. The episode is described by Anna Komnene in the Alexiad, where there is no use of the term aktouarios for any of the physicians, and thus we are unable to tell whether either of the two held the office at that particular time.'?? A further reference from the Empire of Nicaea associates the office with a physician named Nicholas, who is presented as discussing the eclipse of the sun in 1239 with George Akropolites and the Empress Irene in the court of the Emperor John III Vatatzes.’*° The office survived in the Palaiologan period; an aktouarios and physician with the family name Kabasilas announced the imminent death of Michael VIII in 1282." Interestingly, the office is not included in the fourteenth-century treatise on precedence by Pseudo-Kodinos, but it comes in forty-ninth place in the list of precedence in the appendix of the fourteenth-century Hexabiblos of jurist Constantine Harmenopoulos and occupies the same place in the contemporary versified list by the monk and theologian Matthew Blastares.'^?
So far the sources I have presented are silent on the responsibilities of the office and whether the aktouarios was also a permanent court physician, as has often been assumed by scholars.'^? Before drawing any conclusions about this, it is necessary to consider evidence from the group of so-called xenonika, medical texts with a strong pharmacological focus, which are related to the Byzantine xenónes.'^ More specifically, there are three more named physicians, who held the office and practised in Byzantine xenones, as is confirmed in surviving recipes bearing the name and title of the relevant authorphysician. These are Abram the Saracen, aktouarios of the Mangana xenon and basilikos archiatros, Stephen, aktouarios of the Mangana xenon, and Michael, aktouarios of the Mauraganos xenon.'*' In all cases, we can see that the office is connected with a particular xenon, while in the case of Abram the Saracen (most probably indicating an Arab physician), we can see that one aktouarios was also appointed imperial (basilikos) archiatros. Thus he was either associated with the court or he was employed in an imperial xenon (basilikos xenon).'^? As for the title of archiatros, it was used to signify a senior (head) physician in the early Byzantine period, but there is no evidence to attest the consistent existence of the post in later centuries.'?? Moreover, it is not connected with the office of aktouarios in any other source. David Bennett has convincingly shown that there is no evidence for the restoration of the Constantinopolitan Mangana xenon after 1261 and the recipes concerned must be dated to between the mid tenth century (the assumed date of the foundation of the Mangana xenón)'?* and 1204.'% Thus, at some point, most probably between the eleventh and twelfth centuries, some physicians who held the office of aktouarios were practising in the Mangana xenon, but there is no evidence that allows us to generalize about this affiliation with respect to aktouarioi active in the Palaiologan period like John, despite claims to this effect by Timothy Miller.'ó^ As for the reference to the Mauraganos xenon, it remains an enigma, since we have no other evidence of a xenon by this name.'^?
Overall there is neither evidence that the aktouarios was an officially appointed court physician nor that the office was always associated with a position in a Constantinopolitan xenon. In John's case, there is no significant surviving evidence to suggest either of these things.'^* It is certain, however, that John did hold this, most probably, honorific office, as is confirmed by contemporary letters and also its inclusion in the vast majority of the titles in surviving manuscripts of his works.’ The award of this title implies some recognition of his medical services and expertise, might have been associated with a periodic income, "? and shows Andronikos ІГ special respect for him.
4.2 John's literary output
42.1 Dating
John's earliest work is his monograph on uroscopy, On Urines. The chronology is confirmed by John in his Medical Epitome when, in writing about the diagnosis of urine, he refers to his long work on the subject where the reader would find a more detailed discussion." The Medical Epitome was composed for the parakoimémenos Alexios Apokaukos,'? at some point after 1321, since Apokaukos was appointed to this office in the same year.'? According to what John says in his proem to the first book of the Medical Epitome, his reason for writing it was so that it could be taken by Apokaukos on his diplomatic mission to the ‘Hyperborean Ѕсуіћіапѕ’.'”* By ‘Hyperborean Scythians’, John most probably referred to the Tatars of the Golden Horde. We аге not alerted to a particular embassy undertaken by Apokaukos by any contemporary source and thus we cannot be absolutely sure when John began to compose his Medical Epitome." Apokaukos departed earlier than expected, as is confirmed in the last chapter of book one." John started to work on his project again after Apokaukos' return, as we learn from the proem of book two." Meanwhile, we are also informed that after the completion of book one, he wrote his treatise On Psychic Pneuma dedicated to Joseph Rhakendytes.’”’ Joseph left Constantinople around 1326 and died around 1330.'* Thus, not just the completion of the first book of the Medical Epitome but also John's work On Psychic Pneuma would most probably have been composed before 1326 and not later than 1330. At the end of the Medical Epitome there is mention of an Apokaukos going on another diplomatic mission, but John does not provide us with any further details.'?' Thus, we cannot date the completion of the Medical Epitome with certainty either. On the other hand, the potentially partly unfinished nature of John's work in the pharmacological section, as shown in Chapter 5, could suggest that he died unexpectedly, around 1330.'*?
4.2.2 On Urines
The On Urines survives complete or in part in approximately forty manuscripts.'?^ It was first published by Julius Ludwig Ideler, ^? who does not specify what manuscript(s) his edition is based on. The first book has been critically edited by Stavroula Georgiou,' ^? who reproduces the long version of the title of the work, including a reference to John's office and all relevant appellations: "Treatise on urines by the most wise and most erudite, most august, august aktouarios, kyr John Zacharias."
It is a specialized work on uroscopy for expert readers and is divided into seven books. The first serves as an introduction to the theoretical background to the method. The next six books concentrate on diagnosis (books two and three), aetiology (books four and five), and prognosis (books six and seven). John's approach is original both as regards its content and presentation. Several earlier theories on various urinary characteristics are revised and supplemented with the findings of the author himself, who is aware of wider medieval Mediterranean developments in the field. At some points, in presenting his theories, John expands his narration, first by using examples (paradeigmata) from his own engagement with the subject and secondly by embedding texts dealing with case histories (historiai) taken from his extensive clinical experience. This is the first time since Galen, almost twelve centuries earlier, that case histories have been seen in the Greek literature.
4.2.3 Medical Epitome
The Medical Epitome survives complete in twenty-six codices and there are thirteen more manuscripts that retain various fragments and excerpts.'?? It was partly published by Ideler (books опе and two), ?? who—as in the case of On Urines—gives no details about the textual witness(es) that he used to establish the text. The remaining books (three to six) are unedited and are only available through а sixteenth-century Latin translation.'?? In citing passages from the unedited part, I use transcriptions from Vindobonensis med. gr. 17.?' The work is usually mentioned in the literature by the Latin title, Methodo Medendi (Method of Medicine), given to it by its sixteenth-century translator.^^ I prefer to refer to it as the Medical Epitome, since this title corresponds to the title given in the majority of the manuscripts and fits better with its structure and contents.'?? It is dedicated to Alexios Apokaukos, who took a lively interest in medicine. John refers consistently in his work to his friendship (philia) with Apokaukos,'?* which indicates a significant degree of intimacy between the two. Apokaukos is reported by the sources to be a tax collector of substance by 1321, who has already managed to amass a great personal fortune. Thus, John's dedication can be also seen as a strategic plan to secure strong раігопаве.'° A key player in the civil wars of the 1320s and 1340s, Apokaukos had managed to become the single most powerful individual, the de facto ruler of the Empire, shortly before his murder in 1345.'?
As we will see in Chapter 4, the work is mainly written for the non-expert. It is divided into six books. The first two focus on diagnosis and the next two on various therapeutic methods. The last two books (five and six) concentrate solely on the composition of drugs, consisting of both traditional Greek and early Byzantine material, and newly introduced Arabic pharmacological lore. The work is mainly a compilation of earlier material and the author's presence is chiefly noticeable in the proem and epilogue of each book, where he presents his sources and outlines the structure of his work.
4.2.4 On the Activities and Affections of the Psychic Pneuma and the Corresponding Regimen
The On Psychic Pneuma survives in about thirty-five manuscripts dating to between the fourteenth and sixteenth centuries.'?? It was first printed in Greek in the sixteenth сепішгу.!'°° Two further Greek editions were published in the late eighteenth century and early nineteenth century respectively.”°° It was written at the request of John's contemporary, the intellectual monk Joseph Rhakendytes, with the aim of helping the latter to keep his psychic pneuma in a purified state. In the text there is no evidence that John had been a student of Joseph Rhakendytes, as has previously been suggested.” The latter arrived in Constantinople around 1308??? when John, as is confirmed in his correspondence with Lakapenos, was already a practising physician. John sometimes uses the term ‘father’ (pateras) when addressing Joseph, which should be seen in the light of Joseph's status as a member of the clergy and probably reflects a spiritual relationship."?? In the text we are informed about meetings between John and Joseph in which they used to discuss philosophical matters. Joseph was also able to get involved in discussions about medicine with John and could perform venesection.””
The work is divided into two books as follows: theoretical aspects on the formation and roles of various kinds of pneumata (book one) and therapeutic agents (book two) with considerable attention given to diet. Throughout the treatise the psychic pneuma, which is dispersed through the body via the nerves and is responsible for sensory and motor activities, is the subject of significant attention. John introduces a new theory in which each of the four pneumata is correlated with two primary qualities (unnamed, ‘gastric pneuma: cold and moist; natural pneuma: warm and moist; vital pneuma: warm and dry; psychic pneuma: cold and dry). Any disturbance in the quality, for example, of the psychic pneuma may affect its flow and consequently it can be a cause of impairment. Ultimately, John made a direct connection between the quality of pneuma and someone's daily regimen, thus introducing a systematic classification of qualitative change in pneuma as an object of treatment.
4.2.5 John's other works
In the manuscript, Vindobonensis phil. gr. 219, which preserves John's only letter to Theodore Modenos, we find four short poems included immediately after the letter and ascribed to ‘the same author’ (tou аиіои)?% They are iambic epigrams written in praise of certain icons."^ The first epigram refers to the Annunciation, the next two to the Theotokos Brephokratousa (Virgin Mary and Child), and the last one celebrates John the Baptist.””’ The latter epigram refers to brothers Andronikos and John Masgidas (syngonon Masgidadon) as the dedicators of the icon. They most probably belonged to the large family of the Masgigades attested in the area of Serres in the first half of the fourteenth century,"* a place with which John was also connected. Unfortunately, there are no further details, which might permit us to identify the particular icons in question. Since the epigrams were copied together with John's letter, which was most probably written before 1299, it is probable that they were composed when he was young as a kind of school exercise.
In two more cases, we hear of other potential works by John through references in his On Psychic Pneuma and in the Medical Epitome."? In the first case, in the last chapter of book one of On Psychic Pneuma, John writes:
This is not the right time to discuss whether character traits depend on the mixtures of the body; it is better to keep this idea for another instance. However, it is likely to talk specifically about the soul and the traits corresponding to it, and also about its activities and its association with the perceptible and intelligible order.
Here John is clearly alluding to a subject that he would like to deal with in the future and which had been examined most famously in the past by Galen in his treatise The Capacities of the Soul Depend on the Mixtures of the Body.”™* However, we have no evidence that John eventually wrote about this topic.
In the second case, a passage from the unedited third book of his Medical Epitome, which deals with diet, gives further information about another potential work by John:
The passions of the soul cannot be of any help to physicians because they do not follow any kind of «bodily» dyskrasiai. It is presumably better to adduce consolations in order to treat the soul that is swallowed by distress. For this reason I have tried to invent consolation every time I thought it appropriate, and it is possible to learn from there how to console those who happen to become distressed...you will learn all these things when you come across this book.?"?
It is evident from this that John had written a consolatory work (paramythetikos logos), intended to treat psychic distress. The work must have been written before his Medical Epitome, but it does not seem to have survived. This is not a medical treatise, but a psychotherapeutic work, something usually written by ancient philosophers in order to offer practical advice to combat distress."'? The most illustrious example of a physician who is known to have written such a work is the 'physician-cum-philosopher' Galen with his Avoiding Distress (Peri Alypias).?*
4.2.6 John as a reviser of the Greek uroscopic treatise ascribed to Ibn Sina
There is a short treatise in Greek on uroscopy ascribed to the Persian physician and polymath Ibn Sina (d. 1037). The text is found in many manuscripts in three textual forms. According to the title given in a group of textual witnesses, John appears to be the reviser and editor of a version which has recently been critically edited by Mario Lamagna: ‘Excellent treatise on urines by the most wise Ale among Indians, Avitzianos among Greeks, translated crudely into the Greek language by Christodoulos, most skilled in the medical art, and set out in Greek form and syntax by the aktouarios, kyr John Zacharias, most wise and most skilled in the medical агі.
Lamagna has discovered another, unedited, version of the text, which is only ascribed to the otherwise unknown physician mentioned above, one Christodoulos, without, this time, referring to his role as translator of the text.”*° In this form, which according to Lamagna seems to be the model for the later versions, the text is often characterized by improper use of Greek terms and incorrect syntax. Furthermore, the Greek translator/editor has added large sections of explanatory details on human physiology and some brief case histories situated in a Greek environment.?" There is one more version, the briefest, which eliminates the sections on physiology and the case histories, although it is generally close to the Christodoulos version as regards the use of Greek terms.?'?
In my view, in the absence of the original text"? it is not certain that Christodoulos' version is a reworking of a translation from an oriental language into Greek, as has been suggested by Lamagna."^ As I argue in Chapter 2, John was directly influenced by this treatise, since there are at least two uroscopic theories in this work, which are found in no other Byzantine work, apart from John's On Urines. The first of these involves the particular importance given to a urinary characteristic called the 'crown' (stephane) and the other is the notion of the relationship between certain areas in the uroscopic vial and parts of the human body.” Taking into consideration that the latter theory is first found in the works of Salernitan scholars of the twelfth century,””” and that one of the versions of the name of Ibn Sina in Greek often appears in the title of some versions of the work in forms which suggest either a Latin or a vernacular Italian transliteration of his name into Greek,” it is tempting to suggest that the Byzantine version is the result of blending Arabic and Latin uroscopic lore through one or more stages of mediation.
Lamagna informs us that, compared to Christodoulos' version, John's version is indeed an improvement as regards the use of Greek vocabulary and syntax. Furthermore, the long sections on physiology in Christodoulos' version are either summarized or omitted, and there are some additions, including further explanatory information, mainly derived from Theophilos' On Urines and the Hippocratic Aphorisms and the Prognostic."^ Finally, it should be noted that there is not sufficient evidence to date John's own revision of Christodoulos' version precisely, but it must have been before the composition of his On Urines.?”°
4.3 John’s use of language
Lastly, some remarks on John’s use of language may be helpful in elucidating his intellectual background. Bearing in mind that all of John’s works contain what is, for the most part, technical information, there is little room for any great degree of linguistic embellishment.” At times, however, we can glimpse an attempt to use syntactical structures or forms of words, which imitate classical Greek; this is usually more obvious in his proems and epilogues, which afford more opportunities for literary elaboration.
Thus, there is occasional use of the verb echó accompanied by an infinitive to indicate capability," use of the infinitive with the definite article as a noun,?” and use of a singular verb with neuter plural as subject."? Furthermore, we can sometimes see use of the dual number,"? use of the classical comparative form,?! repeated use of krasis when kai comes before a preposition or adverb??? and when the preposition pro comes before a verb.” He also uses hyperbaton.?^ Finally, John's language shows some characteristics of contemporary Byzantine Greek. For instance, we can trace a flexibility in the use of moods in subordinate clauses, e.g. the use of opotan and epeidan with an optative (instead of subjunctive) as a response to a main verb in the present tense,?? and use of the optative (instead of subjunctive) after hina as a response to a main verb in the present tense.?* Moreover, we attest use of etheld with the infinitive to indicate the future," and of double negative.
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